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MLTSS Kristin Murphy.

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Presentation on theme: "MLTSS Kristin Murphy."— Presentation transcript:

1 MLTSS Kristin Murphy

2 Who is the membership? The MLTSS population consists of dual eligibles who have opted-out of MMAI and who are either residing in nursing facilities or receiving waiver services. Chicagoland: 26,729 new members (LTC and waiver) across 6 health plans 9,958 LTC members and 16,771 waiver members If all things are equal across plans: LTC: 1660 members Waiver:  2795 members

3 Preparation for new membership:
Letters being mailed in waves, with the first in June 60 days to pick a plan, then auto-assignment July will be for opt-in membership and those selecting Illinicare Health Increase staffing to cover membership Contract is expected to run through 12/31/19 at earliest

4 10 Essential Elements Adequate Planning and Transition Strategies
Stakeholder Engagement Enhanced Provision of Home and Community Based Services Alignment of Payment Structures with MLTSS Programmatic Goals Support for Beneficiaries Person-Centered Process Comprehensive and Integrated Service Package Qualified Providers Participant Protections Quality

5 Best Practices LOCAL APPROACH
quality healthcare is best delivered locally provide accessible, high quality and culturally sensitive healthcare services to our members care coordination model utilizes integrated programs that can only be delivered effectively by a local staff focus on diversity of staff and provider relationships to serve membership, bridging social, ethnic and economic gaps. CARE COORDINATION partnerships with its trusted providers to ensure members receive the right care, in the right place, at the right time

6 Best Practices continued
HEALTHCARE COMPLIANCE State and Healthcare Effectiveness Data and Information Set (HEDIS) reporting constitutes the core of the information base that drives our clinical quality performance efforts. This reporting is monitored by Quality Improvement Committees Cultural Sensitivity We successfully coordinate care for our diverse membership by recognizing the significance of the many different cultures our members represent and by forming partnerships in communities that bridge social, ethnic and economic gaps.

7 Our Model Engaging Independent Living Centers and Area Agencies on Aging within the community Caregiver support services Direct care workforce initiatives (training, recruitment, retention) Behavioral health and disease management integration Local care coordinators as point of contact Educational and training sessions for members, providers & staff

8 Person-Centered Model
Creative and flexible style targeted at functional status Link consumers and families to medical and non-medical community resources Educational & vocational services, assistive technologies, out of home care and family support to meet their needs, while providing coordinated health care Full, coordinated benefit coverage and value added features Local “boots on the ground” approach Identify barriers Facilitate communication across medical and behavioral health specialties Coordinate services, including transportation and referrals

9 Provider Network Traditional Providers: Hospitals Nursing Facilities
Physician (PCP/SCP) Behavioral Health Disease Management Prescription Drugs Ancillary Services Dental DME Transportation Non-traditional Providers: LTSS Providers Day Services Respite Home Health Services Home Delivered Meals Personal Care Supports Home Modifications Assistive Technology EHRS

10 Resources Alzheimers http://www.alz.org/
Agencies & Organizations Serving Seniors HFS LTSS home page Eldercare Locator Housing Locator News and Publications Medicaid.gov Centers for Independent Living incil.org v/tty Senior Helpline

11 Questions???

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